A hipercolesterolemia familiar (HF) é uma alteração de origem genética comum que pode se manifestar clinicamente desde o nascimento e provoca um aumento nos níveis plasmáticos de LDL-colesterol (LDL-c), xantomas e doença coronária prematura. Sua detecção e tratamento precoce reduzem a morbidade e mortalidade coronária. A identificação e rastreamento em cascata familiar usando níveis de LDL-c e detecção genética é a estratégia mais aconselhável e rentável para descoberta de novos casos. O tratamento crônico com estatinas reduz o risco cardiovascular da população em geral, contudo, estudos clínicos com estatinas revelam risco cardiovascular residual mesmo após correção das concentrações de LDL-c. Com o surgimento de novas drogas e mais recentemente um inibidor da enzima pró-proteína convertase subtilisina/kexina tipo 9 (PCSK9), este estudo enfatizou na investigação específica para aqueles acometidos com defeitos genéticos nessa enzima, por ser de frequência ainda mais rara e pouco estudada, necessitando de melhor investigação na população em estudo a fim de rastrear a ocorrência de mutações patológicas na PCSK9. O objetivo desse estudo foi identificar e caracterizar mutações e/ou deleções patológicas no gene PCSK9 em pacientes com Hipercolesterolemia Familiar provenientes do Hospital das Clínicas de Ribeirão Preto da FMRP/USP selecionados para o teste genético. Foi feito o rastreamento de mutações pelo método Hight Resolution Melting (HRM), de forma prática, rápida e eficiente, onde mutações detectadas foram seqüenciadas. Foram identificadas 7 mutações não patogênicas, caracterizando que a população estudada não apresenta Hipercolesterolemia Familiar associada a mutações no gene PCSK9, fato que não exclui o diagnóstico por outros defeitos genéticas associados a doença. / Familial hypercholesterolemia (FH) is an alteration of common genetic origin that can manifest clinically from birth and which causes an increase in the LDL-cholesterol plasma levels (LDL-c), xanthomas and premature coronary disease. Its early detection and treatment reduce morbidity and coronary mortality. The identification and tracking in familial cascade using levels of LDL-c and genetic detection is the most advisable and profitable strategy to find new cases. The chronic treatment with statins reduces the cardiovascular risk in the population in general. However, clinic studies on statins show a residual cardiovascular risk even after the correction of LDL-c concentrations. With the appearance of new drugs and, more recently, of a proprotein convertase subtilisin/kexin type 9 enzyme inhibitor (PCSK9), this study highlighted the specific investigation for those stricken by genetic defects in this enzyme, once it is even rarer and understudied and needs further investigation in the study\'s population aiming at tracking the occurrence of a pathological mutation in the PCSK9. This study aimed at identifying and characterizing mutations and/or pathological deletions in the PCSK9 gene in patients with Familial Hypercholesterolemia from the RPMS/USP Ribeirão Preto Clinical Hospital which were selected for the genetic test. We performed the mutation tracking by using the High Resolution Melting (HRM) method in a practical, fast and efficient way, where the mutations detected were sequenced. We identified 7 non-pathogenic mutations, showing that the population studied does not present Familial Hypercholesterolemia associated to mutations in the PCSK9 gene, which doesn\'t exclude the diagnosis by other genetic defects associated to the disease.

A hipercolesterolemia familiar (HF) é uma alteração de origem genética comum que pode se manifestar clinicamente desde o nascimento e provoca um aumento nos níveis plasmáticos de LDL-colesterol (LDL-c), xantomas e doença coronária prematura. Sua detecção e tratamento precoce reduzem a morbidade e mortalidade coronária. A identificação e rastreamento em cascata familiar usando níveis de LDL-c e detecção genética é a estratégia mais aconselhável e rentável para descoberta de novos casos. O tratamento crônico com estatinas reduz o risco cardiovascular da população em geral, contudo, estudos clínicos com estatinas revelam risco cardiovascular residual mesmo após correção das concentrações de LDL-c. Com o surgimento de novas drogas e mais recentemente um inibidor da enzima pró-proteína convertase subtilisina/kexina tipo 9 (PCSK9), este estudo enfatizou na investigação específica para aqueles acometidos com defeitos genéticos nessa enzima, por ser de frequência ainda mais rara e pouco estudada, necessitando de melhor investigação na população em estudo a fim de rastrear a ocorrência de mutações patológicas na PCSK9. O objetivo desse estudo foi identificar e caracterizar mutações e/ou deleções patológicas no gene PCSK9 em pacientes com Hipercolesterolemia Familiar provenientes do Hospital das Clínicas de Ribeirão Preto da FMRP/USP selecionados para o teste genético. Foi feito o rastreamento de mutações pelo método Hight Resolution Melting (HRM), de forma prática, rápida e eficiente, onde mutações detectadas foram seqüenciadas. Foram identificadas 7 mutações não patogênicas, caracterizando que a população estudada não apresenta Hipercolesterolemia Familiar associada a mutações no gene PCSK9, fato que não exclui o diagnóstico por outros defeitos genéticas associados a doença. / Familial hypercholesterolemia (FH) is an alteration of common genetic origin that can manifest clinically from birth and which causes an increase in the LDL-cholesterol plasma levels (LDL-c), xanthomas and premature coronary disease. Its early detection and treatment reduce morbidity and coronary mortality. The identification and tracking in familial cascade using levels of LDL-c and genetic detection is the most advisable and profitable strategy to find new cases. The chronic treatment with statins reduces the cardiovascular risk in the population in general. However, clinic studies on statins show a residual cardiovascular risk even after the correction of LDL-c concentrations. With the appearance of new drugs and, more recently, of a proprotein convertase subtilisin/kexin type 9 enzyme inhibitor (PCSK9), this study highlighted the specific investigation for those stricken by genetic defects in this enzyme, once it is even rarer and understudied and needs further investigation in the study\'s population aiming at tracking the occurrence of a pathological mutation in the PCSK9. This study aimed at identifying and characterizing mutations and/or pathological deletions in the PCSK9 gene in patients with Familial Hypercholesterolemia from the RPMS/USP Ribeirão Preto Clinical Hospital which were selected for the genetic test. We performed the mutation tracking by using the High Resolution Melting (HRM) method in a practical, fast and efficient way, where the mutations detected were sequenced. We identified 7 non-pathogenic mutations, showing that the population studied does not present Familial Hypercholesterolemia associated to mutations in the PCSK9 gene, which doesn\'t exclude the diagnosis by other genetic defects associated to the disease.

The liver regulates inflammation during sepsis, and most liver functions are carried out by hepatocytes. Bacterial lipids, including lipopolysaccharide (LPS) and lipoteichoic acid (LTA), can be cleared by hepatocytes, but the underlying mechanisms are uncertain. Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates uptake of LPS by hepatocytes, but it is unknown whether LTA uptake is similarly regulated. Therefore, our objectives were to characterize the PCSK9-regulated pathway of bacterial lipid uptake by hepatocytes by identifying whether low-density lipoprotein (LDL) receptor (LDLR) and LDLR-related protein 1 (LRP1) are the target receptors, and by determining which lipoproteins are involved. To study this pathway, we assessed the uptake of fluorescently-labeled LPS or LTA by human HepG2 hepatocytes using flow cytometry. We pre-treated HepG2 cells with PCSK9, alone or in combination with anti-LDLR or anti-LRP1 antibodies, in order to identify the PCSK9-regulated receptors that are involved, and utilized media containing normal serum or lipoprotein-deficient serum to investigate the lipoprotein- dependence of this pathway. We also determined the roles of LDL and HDL in bacterial lipid uptake through a series of add-back experiments to lipoprotein-deficient serum, and blocked LDLR to confirm that LDLR mediates LDL-dependent uptake. The HepG2 cell response to variable degrees of bacterial lipid uptake was also assessed in a subset of experiments by measuring several cytokines and extracellular alanine aminotransferase (ALT) activity in the cell culture supernatant. We found that PCSK9 regulates LDLR-mediated uptake of both LPS and LTA through an LDL-dependent mechanism, while LRP1 is not involved. Increased bacterial lipid uptake did not result in any hepatocellular injury or cytokine production, as measured by ALT activity and interleukin (IL)-6, IL-8, IL-10, and IL-17 concentrations. In conclusion, we completed our objective of characterizing the PCSK9-regulated pathway of bacterial lipid uptake, and provide supporting evidence for targeting PCSK9 as a novel therapeutic avenue in sepsis. / Thesis / Master of Science (MSc) / Bacterial compounds stimulate inflammation that can be overwhelming during sepsis. Understanding the processes behind uptake and clearance of these compounds may lead to better sepsis treatments. Therefore, our goal was to understand how uptake of two bacterial compounds, lipopolysaccharide and lipoteichoic acid, occurs by liver cells called hepatocytes. Hepatocytes are naturally equipped to clear foreign compounds, so understanding their role in clearing bacterial compounds is important. Another goal was to identify the role of the protein PCSK9 in this uptake process, as treatments targeting PCSK9 could be applied to sepsis once we understand its role in this disease. Our research demonstrates the negative role of PCSK9 in regulating uptake of lipopolysaccharide and lipoteichoic acid through a lipoprotein receptor called LDLR, and identifies the role of lipoproteins in this process. These findings further our understanding of the hepatocyte response to bacterial compounds in relation to sepsis, and identify PCSK9 as a potential target for new sepsis therapies.

Magister Pharmaceuticae - MPharm / Cardiovascular diseases (CVDs) such as ischaemic heart diseases, heart failure and stroke remain a major cause of death globally. Various deep-rooted factors influence CVD development; these include but are not limited to elevated blood lipids, high blood pressure, obesity and diabetes. A considerable number of proteins are involved directly and indirectly in the transport, maintenance and elimination of plasma lipids, including high and low-density lipoprotein cholesterol (HDL-C and LDL-C). There are several mechanisms involved in the removal of LDL particles from systemic circulation. One such mechanism is associated with the gene that encodes proprotein convertase subtilisin/kexin type 9 (PCSK9), which has become an exciting therapeutic target for the reduction of residual risk of CVDs. Currently, statins are the mainstay treatment to reduce LDL-C, and a need exists to further develop more effective LDL-C-lowering drugs that might supplement statins. This study was aimed at contributing to the generation of knowledge regarding the effect of niacin in reducing LDL levels through PCSK9 interaction. The aims/objectives of this study were achieved by utilizing two approaches, which included animal intervention with niacin followed by genetic screening of five prioritized genes involved in cholesterol synthesis and regulation. For animal intervention, 16 vervet monkeys were divided into two groups of eight animals consisting of a control and an experimental (niacin) group. The control group was given a normal standard diet of pre-cooked maize meal throughout the study, while the experimental group received the same diet supplemented with 100 mg/kg of niacin (SR) for 12 weeks. During the niacin intervention, blood was collected at baseline, every four weeks during the treatment period and the end of the washout period. The collected blood was used for biochemical analysis (total cholesterol, triglycerides, LDL-C, and HDL-C) and downstream genetic applications. The second phase included the screening of PCSK9, LDLR, SREBP-2, CETP and APOB-100 using genotyping and gene expression. Niacin administration produced statistically significant increases in plasma HDL-C at fourtime points (T1, T2, T3 and T4), which resulted in an overall increase in plasma HDL-C. Additionally, niacin administration resulted in a slight reduction in LDL-C and total cholesterol levels. Furthermore, the genotyping analysis revealed 13 sequence variants identified in PCSK9, LDLR, SREBP-2, CETP and APOB-100 genes. Five of these variants were predicted to be disease-causing and correlated with gene expression patterns. Three identified PCSK9 variants (H177N, R148S, G635G) were categorized as LOF mutations, and this was supported by a decline in gene expression in animals harbouring these variants. The LDLR also had LOF variants that were the reason for its decreased mRNA expression. Additionally, SREBP-2 proved to be a key mediator of cholesterol pathways. Therefore, the findings of the study conclusively suggest that niacin does increase HDL-C and decrease LDL-C and total cholesterol. Moreover, an interaction between niacin administration and PCSK9 was observed which resulted in decreased gene expression.

Les maladies cardiovasculaires (MCV) demeurent au tournant de ce siècle la principale cause de mortalité dans le monde. Parmi les facteurs de risque, l’hypercholestérolémie et l’obésité abdominale sont directement liées au développement précoce de l’athérosclérose. L’hypercholestérolémie familiale, communément associée à une déficience des récepteurs des lipoprotéines de basse densité (LDLR), est connue comme cause de maladie précoce d’athérosclérose et de calcification aortique chez l’humain. La subtilisine convertase proprotéine/kexine du type 9 (PCSK9), membre de la famille des proprotéines convertases, est trouvée indirectement associée aux MCV par son implication dans la dégradation du LDLR. Chez l'humain, des mutations du gène PCSK9 conduisent soit à une hypercholestérolémie familiale, soit à une hypocholestérolémie, selon que la mutation entraîne un gain ou une perte de fonction, respectivement. Il demeure incertain si les individus porteurs de mutations causant un gain de fonction de la PCSK9 développeront une calcification aortique ou si des mutations entraînant une perte de fonction provoqueront une obésité abdominale. Dans cette étude, nous avons examiné : 1) l’effet d’une surexpression de PCSK9 dans le foie de souris sur la calcification aortique ; 2) les conséquences d’une déficience en PCSK9 (Pcsk9 KO), mimant une inhibition pharmacologique, sur le tissu graisseux. Nous avons utilisé un modèle de souris transgénique (Tg) surexprimant le cDNA de PCSK9 de souris dans les hépatocytes de souris et démontrons par tomographie calculée qu’une calcification survient de façon moins étendue chez les souris PCSK9 Tg que chez les souris déficientes en LDLR. Alors que le PCSK9 Tg et la déficience en LDLR causaient tous deux une hypercholestérolémie familiale, les niveaux seuls de cholestérol circulant ne parvenaient pas à prédire le degré de calcification aortique. Dans une seconde étude, nous utilisions des souris génétiquement manipulées dépourvues de PSCK9 et démontrons que l’accumulation de graisses viscérales (adipogenèse) apparaît régulée par la PCSK9 circulante. Ainsi, en l’absence de PCSK9, l’adipogenèse viscérale augmente vraisemblablement par régulation post-traductionnelle des récepteurs à lipoprotéines de très basse densité (VLDLR) dans le tissu adipeux. Ces deux modèles mettent en évidence un équilibre dynamique de la PCSK9 dans des voies métaboliques différentes, réalisant un élément clé dans la santé cardiovasculaire. Par conséquent, les essais d’investigations et d’altérations biologiques de la PCSK9 devraient être pris en compte dans un modèle animal valide utilisant une méthode sensible et en portant une attention prudente aux effets secondaires de toute intervention. / Cardiovascular disease (CVD) is the leading cause of death in the 21st century. Among risk factors, hypercholesterolemia and abdominal obesity are directly linked to premature development of atherosclerosis. Familial hypercholesterolemia, commonly due to low-density lipoprotein receptor (LDLR) deficiency, is known to cause premature atherosclerosis and aortic calcification in humans. Proprotein convertase subtilisin/kexin 9 (PCSK9), a member of the proprotein convertase family, is indirectly associated with CVD through enhanced LDLR degradation. Mutations in the human PCSK9 gene lead to either familial hypercholesterolemia or hypocholesterolemia, depending on whether the mutation causes a gain or a loss of function, respectively. It is uncertain if individuals carrying mutations causing a gain-of-function of PCSK9 will develop aortic calcification or whether loss-of-function mutations will lead to abdominal obesity. In this thesis, we investigated: 1) the effect of PCSK9 overexpression on aortic calcification; 2) the consequences of PSCK9 deficiency, mimicking pharmacological inhibition of PCSK9 on fat tissue. We employed a transgenic (Tg) mouse model overexpressing mouse PCSK9 and illustrated by micro-computerized tomography that calcification occurs to a lesser extent in PCSK9 Tg mice than in LDLR-deficient mice. While both PCSK9 Tg and LDLR deficiency caused familial hypercholesterolemia, circulating cholesterol levels alone could not dictate the degree of aortic calcification. In another study, we used genetically modified mice lacking PCSK9 and demonstrated that visceral fat accumulation (adipogenesis) is regulated by circulating PCSK9. Thus in the absence of PCSK9, visceral adipogenesis increases likely via post-translational regulation of very-low-density lipoproteins receptors (VLDLR) in the adipose tissue. In conclusion, these two studies highlight the dynamic balance of PCSK9 in different metabolic pathways, making it a key element in cardiovascular health. Consequently, attempts to survey and/or alter PCSK9 biology should be performed in a valid animal model using sensitive methods and with careful attention to side effects of any given intervention.

Les maladies cardiovasculaires (MCV) demeurent au tournant de ce siècle la principale cause de mortalité dans le monde. Parmi les facteurs de risque, l’hypercholestérolémie et l’obésité abdominale sont directement liées au développement précoce de l’athérosclérose. L’hypercholestérolémie familiale, communément associée à une déficience des récepteurs des lipoprotéines de basse densité (LDLR), est connue comme cause de maladie précoce d’athérosclérose et de calcification aortique chez l’humain. La subtilisine convertase proprotéine/kexine du type 9 (PCSK9), membre de la famille des proprotéines convertases, est trouvée indirectement associée aux MCV par son implication dans la dégradation du LDLR. Chez l'humain, des mutations du gène PCSK9 conduisent soit à une hypercholestérolémie familiale, soit à une hypocholestérolémie, selon que la mutation entraîne un gain ou une perte de fonction, respectivement. Il demeure incertain si les individus porteurs de mutations causant un gain de fonction de la PCSK9 développeront une calcification aortique ou si des mutations entraînant une perte de fonction provoqueront une obésité abdominale. Dans cette étude, nous avons examiné : 1) l’effet d’une surexpression de PCSK9 dans le foie de souris sur la calcification aortique ; 2) les conséquences d’une déficience en PCSK9 (Pcsk9 KO), mimant une inhibition pharmacologique, sur le tissu graisseux. Nous avons utilisé un modèle de souris transgénique (Tg) surexprimant le cDNA de PCSK9 de souris dans les hépatocytes de souris et démontrons par tomographie calculée qu’une calcification survient de façon moins étendue chez les souris PCSK9 Tg que chez les souris déficientes en LDLR. Alors que le PCSK9 Tg et la déficience en LDLR causaient tous deux une hypercholestérolémie familiale, les niveaux seuls de cholestérol circulant ne parvenaient pas à prédire le degré de calcification aortique. Dans une seconde étude, nous utilisions des souris génétiquement manipulées dépourvues de PSCK9 et démontrons que l’accumulation de graisses viscérales (adipogenèse) apparaît régulée par la PCSK9 circulante. Ainsi, en l’absence de PCSK9, l’adipogenèse viscérale augmente vraisemblablement par régulation post-traductionnelle des récepteurs à lipoprotéines de très basse densité (VLDLR) dans le tissu adipeux. Ces deux modèles mettent en évidence un équilibre dynamique de la PCSK9 dans des voies métaboliques différentes, réalisant un élément clé dans la santé cardiovasculaire. Par conséquent, les essais d’investigations et d’altérations biologiques de la PCSK9 devraient être pris en compte dans un modèle animal valide utilisant une méthode sensible et en portant une attention prudente aux effets secondaires de toute intervention. / Cardiovascular disease (CVD) is the leading cause of death in the 21st century. Among risk factors, hypercholesterolemia and abdominal obesity are directly linked to premature development of atherosclerosis. Familial hypercholesterolemia, commonly due to low-density lipoprotein receptor (LDLR) deficiency, is known to cause premature atherosclerosis and aortic calcification in humans. Proprotein convertase subtilisin/kexin 9 (PCSK9), a member of the proprotein convertase family, is indirectly associated with CVD through enhanced LDLR degradation. Mutations in the human PCSK9 gene lead to either familial hypercholesterolemia or hypocholesterolemia, depending on whether the mutation causes a gain or a loss of function, respectively. It is uncertain if individuals carrying mutations causing a gain-of-function of PCSK9 will develop aortic calcification or whether loss-of-function mutations will lead to abdominal obesity. In this thesis, we investigated: 1) the effect of PCSK9 overexpression on aortic calcification; 2) the consequences of PSCK9 deficiency, mimicking pharmacological inhibition of PCSK9 on fat tissue. We employed a transgenic (Tg) mouse model overexpressing mouse PCSK9 and illustrated by micro-computerized tomography that calcification occurs to a lesser extent in PCSK9 Tg mice than in LDLR-deficient mice. While both PCSK9 Tg and LDLR deficiency caused familial hypercholesterolemia, circulating cholesterol levels alone could not dictate the degree of aortic calcification. In another study, we used genetically modified mice lacking PCSK9 and demonstrated that visceral fat accumulation (adipogenesis) is regulated by circulating PCSK9. Thus in the absence of PCSK9, visceral adipogenesis increases likely via post-translational regulation of very-low-density lipoproteins receptors (VLDLR) in the adipose tissue. In conclusion, these two studies highlight the dynamic balance of PCSK9 in different metabolic pathways, making it a key element in cardiovascular health. Consequently, attempts to survey and/or alter PCSK9 biology should be performed in a valid animal model using sensitive methods and with careful attention to side effects of any given intervention.

No description available.

Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) is the ninth member of the Ca+2-dependent mammalian proprotein convertase super family of serine endoproteases that is structurally related to the bacterial subtilisin and yeast kexin enzymes. It plays a critical role in the regulation of lipid metabolism and cholesterol homeostasis by binding to and degrading low-density lipoprotein-receptor (LDL-R) which is responsible for the clearance of circulatory LDL-cholesterol from the blood. Owing to this functional property, there is plenty of research interest in the development of functional inhibitors of PCSK9 which may find important biochemical applications as therapeutic agents for lowering plasma LDL-cholesterol. The catalytic domain of PCSK9 binds to the EGF-A domain of LDL-R on the cell surface to form a stable complex and re-routes the receptor from its normal endosomal recycling pathway to the lysosomal compartments leading to its degradation. Owing to these findings, we propose that selected peptides from PCSK9 catalytic domain, particularly its disulphide (S-S) bridged loop1 323-358 and loop2 365-385, are likely to exhibit strong affinity towards the EGF-A domain of LDL-R. Several regular peptides along with corresponding all- dextro and retro-inverse peptides as well as the gain-of-function mutant variants were designed and tested for their regulatory effects towards LDL-R expression and PCSK9-binding in human hepatic HepG2 and mouse hepatic Hepa1c1c7 cells. Our data indicated that disulfide bridged loop1-hPCSK9323-358 and its H357 mutant as well as two short loop2-hPCSK9372-380 and its Y374 mutant peptides modestly promote the LDL-R protein levels. Our study concludes that specific peptides from the PCSK9 catalytic domain can regulate LDL-R and may be useful for development of novel class of therapeutic agents for cholesterol regulation.